Link to:  Medford Mail Tribune 

By Bill Kettler

Both are self-employed. He does custom auto-body work; she teaches fitness classes at her studio in Ruch and provides clients with facials and skin treatments.

Their health-insurance premium — nearly $300 per month for catastrophic coverage with a $5,000 deductible — became an expense they could no longer afford, Charlene Ormonde said.

"You have to get down to the real nitty-gritty," she said while winding down after a fitness class. "Unfortunately, insurance was one of those places we had to cut."

More and more people like the Ormondes are visiting Jackson County's two federally supported nonprofit community clinics: Community Health Center, with offices in Medford, Ashland and White City; and La Clinica, with offices in Medford, Central Point and Phoenix.

At Community Health Center, where the Ormondes now get their health care, the percentage of patients without health insurance has increased dramatically over the past three years.

In 2006, just under half (45 percent) of all patients had no health insurance. By 2008, two in three (66 percent) of CHC's 10,000-plus patients lacked health insurance.

"We get at least one call every day from someone who's lost their health insurance, asking if we can help," said Peg Crowley, Community Health Center's executive director.

"This is a sentinel event," Crowley said. "We haven't seen anything like this in our organization since 1983."

During 2008, 46 percent of La Clinica's 12,000-plus individual patients had no health insurance.

"Typically we're 45 to 55 percent uninsured," said Brenda Johnson, La Clinica's executive director. "We're still right on that mix."

Johnson said patient volume has remained about the same at La Clinica, but the mix of old and new patients has shifted. Established patients who are strapped financially are putting off health care, but new patients are filling the void.

Johnson said some patients are trying to save money by cutting back on their prescription drugs, contrary to their physicians' advice. "They're taking fewer doses, or splitting their pills," she said. "We're trying to educate people to follow their providers' advice."

Both clinics also accept patients who have health insurance. Uninsured patients pay for health care on a sliding scale, based on their ability to pay. That arrangement was a relief for Charlene Ormonde, who was due for a health exam. She said her former physician's office told her she would need to pay $300 up front for the visit.

"And that was just to get in the door," she recalled. "It didn't include lab work."

The federal government provides major funding for the county's two "safety-net" clinics, which serve about one in every nine Jackson County residents. The clinics also depend heavily on donations from community members for support, but many individuals and organizations that have helped the clinics in the past can't afford to make the same contributions they have in prior years. Johnson said donations to La Clinica are down about 30 percent, and Crowley said donations at Community Health are off at least 15 percent.

"Our safety net is severely strained," Crowley said. "Some of our donors' personal portfolios are diminished. It's hard for them to call and say, 'I can't do (my usual contribution) anymore."

Crowley said United Way officials have told her they may have to cut back on their support by as much as 15 percent.

Dental care seems to be something many people are putting off until pain forces them to seek help, Johnson said.

"Pain is a pretty big motivator," Johnson said. "We're seeing people with abscessed teeth."

She said La Clinica's dental program now has a waiting list of 2,500 people.

Both clinics so far have avoided major layoffs. Community Health had to lay off its Ashland site manager, and when a doctor and nurse practitioner left, those positions remained unfilled. Federal grants announced last week as part of the economic stimulus package will help both clinics continue to provide services, Crowley said.

She said the $262,363 grant to CHC will prevent the elimination of 5.5 full-time jobs, and allow the clinic to fill either the vacant physician's position or the nurse practitioner's slot.

Johnson said La Clinica will use its $278,509 grant to hire two new dentists and expand its dental program.

Johnson said she suspects the demand for services at the safety-net clinics will continue to rise as more people lose their jobs or their health insurance or both.

"We're kind of riding the calm before the storm," she said. "Somebody who loses their job in June may not need health care immediately."

Studies by Oregon State University indicate about 36,000 people in Jackson County lack health insurance and have family incomes below 200 percent of the federal poverty level (about $21,500 for an individual, $29,000 for a couple and $44,000 for a family of four).

The two safety-net clinics combined serve about 11,000 of them, said Maria Ramos Underwood, development director for La Clinica.

"Where are the other 25,000 going?" she said. "What happens when they have a medical emergency?"

Reach reporter Bill Kettler at 776-4492 or e-mail bkettler@mailtribune.com.

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